Multiple injuries – in combat and on playing field – can have devastating effects on brain

Two U.S. soliders mark the site of an improvised explosive device they located while on patrol in Afghanistan’s Arghandab Valley in September 2010. Traumatic brain injury, often caused by exposure to IED blasts or roadside bombs, has become one of the ‘signature wounds’ to come out of the fighting in Afghanistan. (Photo by Patrick Baz | AFP/Getty Images)

Last week, researchers at Boston University presented what may be the most solid evidence yet that mild head injuries – if they occur again and again – can have devastating effects on the human brain. Their work, published in the journal Brain, adds to a growing body of research linking repetitive head injuries to chronic brain disease.

Much of the attention around the research has focused on its implications for people who play contact sports, particularly football. But military veterans were also part of the study – and the findings come at a time when both the Pentagon and the Department of Veterans Affairs are starting to take traumatic brain injury more seriously.

In the BU study, researchers analyzed the donated brains of 85 athletes, veterans and civilians with a history of repetitive mild traumatic brain injury, looking for signs of chronic traumatic encephalopathy. CTE is a degenerative neurological disease for which symptoms include irritability, depression, heightened suicide risk and memory loss. In its most severe later stages, it can also trigger dementia and tremors. The research team also interviewed brain donors’ families and friends, to catalog past incidents of traumatic brain injury. The study’s authors concluded that “for some athletes and war fighters, there may be severe and devastating long-term consequences of repetitive brain trauma that has traditionally been considered only mild.”

Sixty-four of the brains studied came from athletes (some of whom were also military veterans), including 58 who played football at the high school level or higher. [We’ve previously covered contact sports and head injuries here.]

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But the study, conducted in partnership with the VA Boston Health Care System, also found evidence of CTE in the brains of several veterans. That adds urgency to the military’s growing concern about traumatic brain injury, which has emerged, along with post-traumatic stress disorder, as one of the “signature injuries” of the wars in Iraq and Afghanistan.

“Operation Iraqi Freedom and Operation Enduring Freedom were different kinds of war, with a lot more blast injuries,” says neuropsychologist Cynthia Boyd. Boyd is one of the senior scientific directors at the San Diego branch of the Defense and Veterans Brain Injury Center (DVBIC), where doctors and scientists have been researching traumatic brain injury and caring for afflicted veterans and active-duty military since 1992. She says she’s seen thousands of veterans and active-duty service members arrive at the center with injuries caused by improvised explosive devices and roadside bombs.

“The good news is, military medicine is so advanced, we save a lot of lives,” Boyd says. But instead of being killed in combat, “service members come home with brain injuries.”

Since 2000, according to figures from the Armed Forces Health Surveillance Center, more than 250,000 service members have been diagnosed with traumatic brain injury. These numbers don’t just represent combat injuries; according to DVBIC, the majority of TBIs occur in non-combat situations, like training, especially as the wars in Iraq and Afghanistan wind down.

And the military is taking the threat of TBI seriously.

New Department of Defense regulations issued in September mandate a 24-hour rest period from duty for service members involved in a ‘potentially concussive event’ while deployed. If a service member has suffered multiple concussions or brain injuries, return to duty is to be delayed a week or more.

And just last Friday, the Department of Veterans Affairs proposed changes that would expand eligibility for TBI-related disability benefits claims. If approved, the revisions would allow veterans diagnosed with service-related TBI who now experience dementia, seizures, difficulty walking or talking, depression or hormone deficiency to file for disability benefits for those illnesses from the VA. The new regulations are based on the growing body of research indicating that repeated traumatic brain injury can lead to significant health consequences later in life.

So what does all this mean for service members and veterans? For one thing, it raises practical questions about disability benefits claims. For several months, we’ve been reporting on the long wait times for service-related disability benefits. Nationally, it takes the VA an average of 262 days to process benefits claims; in some cities, the wait time can stretch to more than a year. New claims for TBI-related disability benefits may add considerable strain to a system that’s already overtaxed.

But it also reinforces something that’s come up again and again in our reporting on veterans’ health and the VA system: Caring for veterans is a long-term proposition, not something that ends when deployment does. As last week’s report out of Boston and the VA’s new stance on TBI-related disabilities clearly show, the injuries sustained in service can play out over the course of a lifetime. So while the wars in Iraq and Afghanistan might be winding down, the service members who fought them will be dealing with the physical costs of war for years to come.

Reporter/producer Samara Freemark joined the Public Insight Network after four years at Radio Diaries in New York City, where she spent her time helping ordinary people tell their extraordinary stories for NPR. In the process, she developed an unshakeable belief in the beauty and power of personal narrative.

Before Radio Diaries Samara worked as an environmental reporter, a posting that took her to sinking islands, Superfund sites, and literal snakepits – Burmese pythons, to be exact. She also churned out copy and tape in the newsroom of WUOM Ann Arbor. Before settling on a career in radio she tried out policy research, community organizing, and urban planning before deciding she preferred soundwaves to spreadsheets.